Confidential Guardian Screening

Important! This form is private. Only the judge, the investigator, and the person who is filing the petition, called the “petitioner”, will see it. Each person who is applying to become a guardian, called the “proposed guardian,” must fill out this form and give it to the petitioner. The petitioner must file the completed and signed forms of each of the proposed guardians with the court at the same time he or she files the Petition for Appointment of Guardianship (Form GC-210).

This form is NOT to be attached to the petition.

NOTE TO THE PROPOSED GUARDIAN: YOU MAY WANT TO TALK TO AN ATTORNEY BEFORE ANSWERING ANY PART OF THIS FORM.

1.

Proposed guardian (name) - Write your name;

Write the month, day and year you were born;

Write your social security number;

Write your driver’s license number here. Include the state where the license was issued;

Write all the telephone numbers where you can be reached.

2.

Check the box “I am” if you must register as a sex offender under California Penal Code section 290. Explain this on a separate page that you will label “Attachment 2.” Otherwise check the “I am not” box.

3.

Check the box “I have” If you have ever been charged with, arrested for, or convicted of a felony or misdemeanor crime. This includes arrests for drug or alcohol-related offenses. Explain this on a separate page that you will label “Attachment 3.” Also check the box stating specifically if you have been arrested for drug or alcohol-related offenses. Otherwise check the “I have not” box.

4.

Check the box “I have” if you have had a restraining order or protective order filed against you in the last 10 years. Explain this on a separate page that you will label “Attachment 4.” Otherwise check the “I have not” box.

5.

Check the box “I am” if you have a mental health-related issue and are receiving services from a psychiatrist, psychologist, or therapist. Explain this on a separate page that you will label “Attachment 5.” Otherwise check the “I am not” box.

6.

Check the “Yes” box if you or any person living in your home have an assigned social worker, parole officer, or probation officer. Explain why and give the name and address of each social worker, parole officer, or probation officer on a separate page that you will label “Attachment 6.” Otherwise check the “No” box.

7.

Check the “Yes” box if you or any person living in your home has been charged with, arrested for, or convicted of any form of child abuse, neglect, or molest. Explain this on a separate page that you will label “Attachment 7.” Otherwise check the “No” box.

8.

Check the “I am” box if you know of any reports about child abuse, neglect, or molest that have been made to law enforcement or other agencies about you or someone living in your home. Explain this and give the name and address of each agency on a separate sheet that you will label “Attachment 8.” Otherwise check the “I am not” box.

9.

Check the “Yes” box if you or any person living in your home has been in the habit of using any illegal substances or abusing alcohol. Explain this on a separate page that you will label “Attachment 9.” Otherwise check the “No” box.

At the top of page 2, GC-212

Fill out the caption boxes as follows:

“Check the box “Guardianship“ - and write in the child’s full name.

Case Number: Write in the case number.
(the same number as on page 1)

10.

Check the “Yes” box if you or any person living in your home has been charged with, arrested for, or convicted of a crime involving illegal substances or alcohol. Explain this on a separate page that you will label “Attachment 10.” Otherwise check the “No” box.

11.

Check the “Yes” box if you or any person living in your home suffers from mental illness. Explain this on a separate page that you will label “Attachment 11. ” Otherwise check the “No” box.

12.

Check the “Yes” box if you have any physical disability that might make it difficult for you to do all the things needed to care for a child. Explain this on a separate page that you will label “Attachment 12.” Otherwise check the “No” box.

13.

Check the “I have or may have” if you have (or think you have) a legal, money, or other interest that might affect the child for whom you would be a guardian. Explain this on a separate page that you will label “Attachment 13.” Otherwise check the “I do not have” box.

14.

Check the box “I have” if you have been appointed guardian, conservator, executor, or fiduciary for another person or estate in any other court proceeding. Explain this on a separate page that you will label “Attachment 14.” Otherwise check the “I have not” box.

15.

Check the “I have” box if you have been removed as guardian, conservator, executor, or fiduciary in any other case. Explain this on a separate page that you will label “Attachment 15.” Otherwise check the “I have not” box.

16.

Check the “I am” box if you are a private professional fiduciary according to Business and Professions Code Section 6501(f). Otherwise check the “I am not” box.

If you are not a private professional fiduciary, skip question #17 and move on to #18.

17.

If you are a private professional fiduciary, check the “I am” box if you have a current license from the Professional Fiduciaries Bureau of the Department of Consumer Affairs. Otherwise check the “I am not” box.

In either case, complete and sign the Professional Fiduciary Attachment form (GC-210(A-PF)/GC-310(A-PF)). Attach it to the Petition, or deliver it to the petitioner for attachment before the Petition is filed. See item 4d of the Petition.)

18.

Check the “I am” box if you are a corporate officer of a nonprofit charitable corporation acting as a guardian according to Probate Code Section 2104. Otherwise check the “I am not” box. If you checked the “I am” box explain to the court how you are caring for, counseling and providing financial aid to the proposed ward on a separate sheet, labeled “Attachment 18”.

19.

Check the “I have” box if you have filed for bankruptcy protection at any time in the last 10 years. Otherwise check the “I have not” box.

MINOR'S CONTACT INFORMATION

20.

Write in the child’s name, the school that he or she attends, and the home, school or other telephone numbers where the child can be reached.

21.

If there is a second child, give the same information for this child.

22.

If there is a third child, give the same information for this child. (If there are more than 3 children, attach an extra sheet of paper with the same information for any other children.)

DECLARATION

You are promising underpenalty of perjurythat everything you have written on this form is true and correct.